Mahajan Ravi Kumar, Srinivasan Krishnan, Bhamre Abhiskek, Singh Mahipal, Kumar Prakash, Tambotra Ankush
Department of Plastic and Reconstructive Surgery, Amandeep Hospital and Clinics, GT Road, Model Town, Amritsar 143001, Punjab, India.
Amandeep Hospital and Clinics, GT Road, Model Town, Amritsar 143001, Punjab, India.
Indian J Plast Surg. 2018 Jan-Apr;51(1):24-32. doi: 10.4103/ijps.IJPS_121_17.
Many flaps have been described for reconstruction of lower extremity defects, including, Latissimus Dorsi, Rectus abdominis, Anterolateral thigh perforator flaps, each having advantages and disadvantages. The defect location, size and specific geometric pattern of defect influences the type of flap that can be used. In this case series, we describe the specific situations where the use of chimeric latissimus dorsi-serratus anterior (LD + SA) free flaps are of advantage in providing complete wound cover.
Case records of all patients who underwent LD + SA free flap transfer for lower extremity trauma at Amandeep Hospital, from Feb 2006 to Feb 2017 were reviewed. Patients were categorised based on the anatomical location and size of defect. The method of usage of the chimeric segments, recipient vessels and type of anastomosis were noted. Flap complications, if any were reviewed.
47 patients with lower limb defects were included in the study. All cases were post traumatic in nature. Defect size ranged from 180 sq cm to 1050 sq cm. Average defect size was 487.70 sq cm. All patients underwent soft tissue reconstruction with LD + SA flap. Complete wound cover was obtained.
Latissimus dorsi + Serratus anterior free tissue transfer is an effective, reliable method of providing cover to extensive lower limb traumatic defects with minimal donor site morbidity, with added freedom of inset and flap positioning. Specific use is seen in patients with broad proximal defect, long defect in the leg, defects involving adjacent anatomical areas and in large defect with dead space.
已经描述了许多用于重建下肢缺损的皮瓣，包括背阔肌皮瓣、腹直肌皮瓣、股前外侧穿支皮瓣，每种皮瓣都有其优缺点。缺损的位置、大小和特定的几何形状会影响可使用的皮瓣类型。在本病例系列中，我们描述了使用背阔肌-前锯肌嵌合游离皮瓣（LD+SA）在提供完整伤口覆盖方面具有优势的具体情况。
回顾了2006年2月至2017年2月在阿曼迪普医院接受LD+SA游离皮瓣转移治疗下肢创伤的所有患者的病例记录。根据缺损的解剖位置和大小对患者进行分类。记录嵌合段的使用方法、受区血管和吻合类型。如有皮瓣并发症，进行回顾。
47例下肢缺损患者纳入本研究。所有病例均为创伤后所致。缺损面积从180平方厘米到1050平方厘米不等。平均缺损面积为487.70平方厘米。所有患者均采用LD+SA皮瓣进行软组织重建，获得了完整的伤口覆盖。
背阔肌+前锯肌游离组织转移是一种有效、可靠的方法，可为广泛的下肢创伤性缺损提供覆盖，供区并发症最少，在皮瓣植入和定位方面具有更大的自由度。在近端缺损较宽、腿部缺损较长、涉及相邻解剖区域的缺损以及伴有死腔的大缺损患者中可见其特殊用途。
